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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 3/2004

01-03-2004 | Original Contribution

Surveillance for Dysplasia in Patients With Inflammatory Bowel Disease: A National Survey of Colonoscopic Practice in New Zealand

Authors: Richard B. Gearry, M.B.Ch.B., Christopher J. Wakeman, M.B.Ch.B., Murray L. Barclay, M.D., F.R.A.C.P., Bruce A. Chapman, M.B.Ch.B., F.R.A.C.P., Judith A. Collett, M.B.Ch.B., F.R.A.C.P., Michael J. Burt, Ph.D., F.R.A.C.P., Frank A. Frizelle, M.B.Ch.B., M.Med.Sc., F.R.A.C.S.

Published in: Diseases of the Colon & Rectum | Issue 3/2004

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BACKGROUND

Patients with chronic ulcerative colitis and Crohn’s colitis have an increased risk of colorectal cancer. Because of this, surveillance colonoscopy is practiced.

AIMS

We aimed to describe the practice of surveillance colonoscopy in New Zealand, with comparison among specialties, and with practice internationally.

SUBJECTS

New Zealand colonoscopists (both physicians and surgeons) looking after patients with inflammatory bowel disease were surveyed to evaluate attitudes about surveillance colonoscopy and ways in which colonoscopy results are interpreted.

METHODS

A postal survey assessed the colonoscopist’s understanding of how and why surveillance colonoscopy is undertaken and their interpretation of the results from such evaluations.

RESULTS

Of the196 physicians and surgeons surveyed, 180 responded (92 percent). Sixty responses were excluded. Only 24 of 120 respondents (20 percent) correctly defined dysplasia. The median number of biopsies taken at colonoscopy was 17. Eighty of 120 (67 percent) and 77 of 120 (64 percent) doctors underestimate the risk of invasive malignancy if low-grade or high-grade dysplasia, respectively, is identified. The colectomy referral rate for dysplasia-associated lesion or mass was 115/120 (96 percent); that for high-grade dysplasia was 110/120 (92 percent); and that for low-grade dysplasia was 26/120 (22 percent). Thirty of 120 (25 percent) doctors offer patients the option of colectomy after 20 years of colitis. Seventy of 120 (58 percent) doctors sought the opinion of a second pathologist if dysplasia was found. There were differences in responses between specialist groups, with colorectal surgeons most likely to correctly define dysplasia and appreciate the significance of low-grade dysplasia.

CONCLUSIONS

Many New Zealand colonoscopists have a poor understanding of the definition and importance of dysplasia associated with colitis. Although colectomy referral rates are higher in this study than in similar studies, low-grade dysplasia is often not referred for colectomy. Improved education may improve surveillance practice.
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Literature
1.
Eaden, JA, Abrams, KR, Mayberry, JF 2001The risk of colorectal cancer in ulcerative colitis: a meta-analysisGut4852635
2.
Lindberg, B, Persson, B, Veress, B, Ingelman-Sundberg, H, Grankvist, H 1996Twenty years colonoscopic surveillance of patients with ulcerative colitis. Detection of dysplastic and malignant transformationScand J Gastroenterol311195204
3.
Ekbom, A, Helmick, C, Zack, M, Adami, HO 1990Ulcerative colitis and colorectal cancer: a population-based studyN Engl J Med323122833
4.
Gyde, SN, Prior, P, Allen, RN,  et al. 1988Colorectal cancer in ulcerative colitis: a cohort study of primary referrals from three centresGut2920617
5.
Ullman, TA 2002Cancer in inflammatory bowel diseaseCurr Treat Options Gastroenterol516371
6.
Korelitz, BI 1989Inflammatory bowel disease and cancerBerk, JEHaubrich, WEKalser, MH eds. Bockus gastroenterology. Volume 44th edW.B. SaundersPhiladelphia143577
7.
Choi, PM, Nugent, FW, Schoetz, DJ, Silverman, ML, Haggitt, RC 1993Colonoscopic surveillance reduces mortality from colorectal cancer in ulcerative colitisGastroenterology10541824
8.
Eaden, JA, Ward, BA, Mayberry, JF 2000How gastroenterologists screen for colonic cancer in ulcerative colitis: an analysis of performanceGastrointest Endosc511238
9.
Sachar, DB 1993Clinical and colonoscopic surveillance in ulcerative colitis: are we saving colons or saving livesGastroenterology1055889
10.
Karlen, P, Kornfeld, D, Brostrom, O, Persson, P-G, Ekbom, A 1998Is colonoscopic surveillance reducing colorectal cancer mortality in ulcerative colitis? A population based case control studyGut427114
11.
Kornbluth, A, Sachar, DB 1997Ulcerative colitis practice guidelines in adultsAm J Gastroenterology9220411
12.
Anonymous. Guidelines for colorectal cancer screening and surveillance. Gastrointest Endosc 2000;51:777–82.
13.
Eaden, JA, Mayberry, JF 2002British Society for Gastroenterology. The Association of Coloproctology for Great Britain and Scotland. Guidelines for screening and surveillance of asymptomatic colorectal cancer in patients with inflammatory bowel diseaseGut51V102
14.
Bernstein, CN, Weinstein, WM, Levine, DS, Shananan, F 1995Physician’s perceptions of dysplasia and approaches to surveillance colonoscopy in ulcerative colitisAm J Gastroenterol90210914
15.
Hannauer, SB 2000Surveying surveillance: are gastroenterologists consistently inconsistent, inconsistently consistent, or poorly educatedGastrointest Endosc512402
16.
McKenna, BJ, Appelman, HD 2002Dysplasia can be a pain in the gutPathology (Phila)3451828
17.
Berstein, CN, Shanahan, F, Weinstein, WM 1994Are we telling patients the truth about surveillance colonoscopy in ulcerative colitis?Lancet343714
18.
Eaden, J, Abrams, K, McKay, H, Denley, H, Mayberry, J 2001Inter-observer variation between general and specialist gastrointestinal pathologists when grading dysplasia in ulcerative colitisJ Pathol1941527
19.
The New Zealand Medical Register. 2001. Medical Council of New Zealand, Wellington, New Zealand.
20.
Riddell, RH, Goldman, H, Ransohoff, DF,  et al. 1983Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applicationsHum Pathol1493168
21.
Ransohoff, DF 1988Colon cancer in ulcerative colitisGastroenterology94108991
22.
Foxworthy, DM, Wilson, JA 1985Crohn’s disease in the elderly. Prolonged delay in diagnosisJ Am Geriatr Soc334925
23.
Wengrower, D, Goldin, E, Fich, A, Granot, E 1997Crohn’s disease in late adolescence: acute onset or long-standing disease?J Clin Gastroenterol242246
24.
Riddell, RH 1990Screening strategies in gastrointestinal cancerScand J Gastroenterol Suppl17517784
25.
Lashner, BA, Hanauer, SB, Silverstein, MD 1988Optimal timing of colonoscopy to screen for cancer in ulcerative colitisAnn Intern Med1082748
26.
Warren, S, Sommers, SC 1948Cicatrizing enteritis (regional enteritis) as a pathological entity: analysis of one hundred and twenty casesAm J Pathol24475501
27.
Friedman, S, Rubin, PH, Bodian, C, Goldstein, E, Harpaz, N, Present, DH 2001Screening and surveillance colonoscopy in chronic Crohn’s colitisGastroenterology1208206
28.
Rubin, CE, Haggitt, RC, Burmer, GC, Brentnall, TA, Stevens, AC 1992DNA aneuploidy in colonic biopsies predicts future development of dysplasia in ulcerative colitisGastroenterology103161120
29.
Taylor, BA, Pemberton, JH, Carpenter, HA,  et al. 1992Dysplasia in chronic ulcerative colitis: implications for colonoscopic surveillanceDis Colon Rectum359506
30.
Cohen, RD, Hanauer, SB 1995Surveillance colonoscopy in ulcerative colitis: is the message loud and clearAm J Gastroenterol9020902
31.
Woolrich, AJ, DaSilva, MD, Korelitz, BI 1992Surveillance in the routine management of ulcerative colitis: the predictive value of low grade dysplasiaGastroenterology1034318
32.
Greenson, JK 2002Dysplasia in inflammatory bowel diseaseSemin Diagn Pathol19317
33.
Lashner, BA 1992Recommendations for colorectal cancer screening in ulcerative colitis: a review of research from a single university-based surveillance programAm J Gastroenterol8716875
34.
Lennard-Jones, JE, Melville, DM, Morson, BC, Ritchie, JK, Williams, CB 1990Precancer and cancer in extensive ulcerative colitis; findings among 401 patients over 22 yearsGut318006
35.
Ullman, TA, Loftus, EV, Kakar, S, Burgart, LJ, Sandborn, WJ, Tremaine, WJ 2002The fate of low grade dysplasia in ulcerative colitisAm J Gastroenterol979227
36.
Thompson-Fawcett, MW, Richard, CS, O’Connor, BI, Cohen, Z, McLeod, RS 2000Quality of life is excellent after a pelvic pouch for colitis associated neoplasiaDis Colon Rectum431497502
37.
Kohler, LW, Pemberton, JH, Zinsmeister, AR, Kelly, KA 1991Quality of life after proctocolectomy. A comparison of Brooke ileostomy, Kock pouch and ileal pouch–anal anastomosisGastroenterology10267984
38.
Rubio, CA, Befrits, R, Ljung, T, Jaramillo, E, Slezak, P 2001Colorectal carcinoma in ulcerative colitis is decreasing in Scandinavian countriesAnticancer Res2129214
39.
Rubio, CA, Befrits, R 1997Colorectal adenocarcinoma in Crohn’s disease: a retrospective histologic studyDis Colon Rectum4010728
40.
Askling, J, Dickman, PW, Karlen, P,  et al. 2001Family history as a risk factor for colorectal cancer in inflammatory bowel diseaseGastroenterology120135662
41.
Nuako, KW, Ahlquist, DA, Mahoney, DW, Schaid, DJ, Siems, DM, Lindor, NM 1998Familial predisposition for colorectal cancer in chronic ulcerative colitis: a case-control studyGastroenterology115107983
42.
Kornfeld, D, Ekbom, A, Ihre, T 1997Is there an increased risk for colorectal cancer in patients with ulcerative colitis and concomitant primary sclerosing cholangitis? A population based studyGut4152255
43.
Loftus, EV, Sandborn, WJ, Tremaine, WJ,  et al. 1996Risk of colorectal neoplasia in patients with primary sclerosing cholangitisGastroenterology11062830
44.
Loftus, EV, Aguilar, HI, Sandborn, WJ,  et al. 1998Risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis following orthotopic liver transplantationHepatology2768590
45.
Ekbom, A, Kornfeld, D 1996Sulphasalazine use as a preventative factor for colorectal cancer in ulcerative colitis patients: a reviewInflamm Bowel Dis22768
46.
Allgayer, H, Kruis, W 2002Aminosalicylates: potential antineoplastic actions in colon cancer preventionScand J Gastroenterol3712531
47.
Bernstein, CN, Eaden, J, Steinhart, AH, Munkholm, P, Gordon, PH 2002Cancer prevention in inflammatory bowel disease and the chemoprophylactic potential of 5-aminosalicylic acidInflamm Bowel Dis835661
Metadata
Title
Surveillance for Dysplasia in Patients With Inflammatory Bowel Disease: A National Survey of Colonoscopic Practice in New Zealand
Authors
Richard B. Gearry, M.B.Ch.B.
Christopher J. Wakeman, M.B.Ch.B.
Murray L. Barclay, M.D., F.R.A.C.P.
Bruce A. Chapman, M.B.Ch.B., F.R.A.C.P.
Judith A. Collett, M.B.Ch.B., F.R.A.C.P.
Michael J. Burt, Ph.D., F.R.A.C.P.
Frank A. Frizelle, M.B.Ch.B., M.Med.Sc., F.R.A.C.S.
Publication date
01-03-2004
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 3/2004
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-003-0049-y

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